13090058 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20920 MCCLELLAN RD CONTRACTOR:SWEET CONSTRUCTION PERMIT NO:13090058
OWNER'S NAME: RECTOR WARDENS VESTRYMEN OF ST JUDE 1129 PALM AVE DATE ISSUED:09/10/2013
OWNER'S PHONE: 4082524166 REDWOOD CITY,CA 94061 PHONE NO:(650)771-2065
n LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
License Class 15 Lic. SAINT JUDE EPISCOPAL CHURCH-ADD(4)LIGHT POLES
TO PARKING LOT
Contractor A
/Chapter hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35920028.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter WITHIN 1 0 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may,acr agalust said Ci W consequence of the
P
granting of this permit. Additio ipn an rstands and will comply Issued by: Date:
with all non-point r e reg n—ft)FY- er eCu no Municipal Code,Section
'
9.18.
RE-ROOFS:
Signature e Ae Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
1Z installed without first obtaining an inspection,I agree to remove all new materials for
inspection,
n fol OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self insure for Worker's material. Additionally,should I use equipment or devicy0which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area aJW Management District I
performance of the work for which this permit is issued. will maintain compliance with the C erti I I Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 5 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes,(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20920 me clellan DATE: 09/10/2013 REVIEWED BY: Mendez
gig] APN: BP#: *VALUATION: $20,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 10EAP12
USE: PERMIT TYPE:
wORK saint'ude episcopal church-add lighting to parking lot
SCOPE
-7-7777
iec:h.
Plan(Ji ef�& lahimb.Mao Elec.Plan Check 0.0 1 hrs $0.00
PermitF'ee T Itxmb.PBr'rnil dr"ee.� Elec.Permit Fee: IEPERMIT
oY1PE r ;9ec'r r.lnyp, Oiher 1'/amb insp. Lj tither Elec.Insp. Fo.o hrs $47.00
I och. /nspJ tr"">:e: 1 fz nha fnsp? 1 <t: C;ic.e,Into Fee:
' E_
NOTE;This estimate does not include fees due to other Departments(%e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,ELa2. These ees are based on the EEdindna information available and are onLy an estimates Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 Ef, 711112,E FEE QTYlFEE MISC ITEMS
Plan Check Fee: $0.00 = # Electrical
Suppl.PC Fee: Reg. 0 OT 0 0 hrs $0.00 $64.00 1BREMPOLE Fixtures,Pole Lighting
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:• Reg. 0 OT 4,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction Tax, LJ
Administrative Fee: 1ADMIN $44.00 0
Work Without Permit? 0 Yes 0 No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRAVDOC $47.00 1
Building or Structure
Strong Motion.Fee: IBSEISMMO $4.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
S-URTOTIALSd $143.20 $64.00 TOTAL FEVv $207.20
Revised: 07/01/2013